Risk factors for femoral fracture in lateral decubitus direct anterior approach total hip arthroplasty using conventional stems: a retrospective analysis

Sun, Guanjun; Yin, Yi; Ye, Yongjie; Liu, Qingshan

doi:10.1186/s13018-021-02253-4

Cited by 4 publications

(3 citation statements)

References 28 publications

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“…In spite of the above mentioned advantages, the DAA is not the panacea of surgical approaches to the hip, as it has been associated with a significant learning curve (23)(24)(25)(26) an increased risk of lateral femoral cutaneous nerve neuropraxias (15,27), higher rates of intra-operative femoral fractures (15,28), greater rates of early femoral revision (29,30) (LFCN and an increased risk of wound complications (31,32).…”

Section: Current Perspectives Of South African Orthopaedic Surgeons T...mentioning

confidence: 99%

Current perspectives of south african orthopaedic surgeons to the direct anterior approach in total hip arthroplasty

Pietrzak,

Geldenhuys,

Sikhauli

et al. 2024

E Af Orth Jnl

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Background: Despite the global increase in popularity for the use of the Direct Anterior Approach (DAA) for Total Hip Arthroplasty (THA), the current beliefs and reasons for its use and disuse amongst South African orthopaedic surgeons is not well understood. Objective: To determine the perspectives regarding DAA compared to other surgical approaches to THA. Methods: We conducted an anonymous online survey sent to all current members of the South African Orthopedic Association (SAOA). Results: The response rate was 24.25% (n=194). There were 76 (39.18%) respondents that have performed DAA (DAA Performers) and 118 (60.82%) that have never performed DAA (DAA nonperformers). A proportion of 50% and 11.84% of DAA performers were between 30 to 45 years and older than 60 years of age, respectively (p<0.000). The DAA is the preferred approach to THA for 36.84% (n=28) of DAA performers, whilst 63.16% (n=48) prefer an alternative approach. Both DAA performers who prefer DAA and those who prefer alternative approaches consider DAA more satisfactory for length of hospital stay (p<0.000) and short-term functional outcomes (p=0.002) compared to other surgical approaches. For DAA non-performers, the primary reasons for not performing DAA THA were inexperience in surgical technique (72.09%), increased operative time (12.79%), unsatisfactory outcomes (27.91%) and learning curve (67.44%). There were 5 (18.52%) and 30 (70.33%) surgeons who have been in clinical practice for more than 10 years that do and do not intend to use DAA in the future, respectively (p<0.000). Conclusion: The trends of the adoption of the DAA by South African orthopaedic surgeons show increasing popularity, similar to patterns seen in the United Kingdom and the United States of America. Younger surgeons are more likely to perform the DAA THA whilst more experienced surgeons are less likely to deviate from their current standard of practice.

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Section: Current Perspectives Of South African Orthopaedic Surgeons T...mentioning

confidence: 99%

Current perspectives of south african orthopaedic surgeons to the direct anterior approach in total hip arthroplasty

Pietrzak,

Geldenhuys,

Sikhauli

et al. 2024

E Af Orth Jnl

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“…Currently, it is recognized that the main reasons for fracture are the improper practice and the difference in stiffness between the bone and implant 12 . OP is also a predisposing factor for the intraoperative fracture in the femoral isthmus because of the reduction in bone density and deterioration of bone microarchitecture 13–15 . OP has been reported as the major cause of an estimated nine million osteoporotic fractures 16 .…”

Section: Introductionmentioning

confidence: 99%

“… 12 OP is also a predisposing factor for the intraoperative fracture in the femoral isthmus because of the reduction in bone density and deterioration of bone microarchitecture. 13 , 14 , 15 OP has been reported as the major cause of an estimated nine million osteoporotic fractures. 16 Previous studies showed that the rate of subsequent fracture decreased by 50% in patients who received osteoporosis treatment.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Characteristics of the Femoral Isthmus during Total Hip Arthroplasty in Patients with Adult Osteoporosis and Developmental Dysplasia of the Hip: A Finite Element Analysis

Sun

Zhang

Liu

et al. 2022

Orthopaedic Surgery

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Objective This study investigated the underlying mechanisms of high fracture incidence in the femoral isthmus from a biomechanical perspective. Methods We retrospectively analyzed a total of 923 primary total hip arthroplasty (THA) patients and 355 osteoporosis (OP) patients admitted from January 2010 to January 2018. Through a series of screening conditions, 47 patients from each group were selected for inclusion in the study. The datasets on the unaffected side and affected side of the patients with unilateral developmental dysplasia of the hip (uDDH) were respectively classified as the normal group (Group I) and he tDDH group (Group II), and that of patients with osteoporosis were classified as the OP group (Group III). In this study, first, we collected computed tomography (CT) images and measured geometric parameters (inner and outer diameters) of the isthmus. Thereafter, to study biomechanical properties, we established six finite element models and calculated values of von Mises stress for each group with the methods of data conversion and grid processing. Results Compared with those of patients in the normal group, the values of the inner and outer diameters of femoral isthmus of patients in the DDH group were significantly lower (P < 0.001), while the inner diameters of patients in the OP group were significantly higher (P < 0.001) and the outer diameters of patients in the OP group showed no significant difference (P> 0.05). The cortical rates of patients in the normal group and the DDH group appeared insignificant (P > 0.05), and those of patients in normal group were significantly higher than those of patients in the OP group (P < 0.001). Moreover, patients in the DDH group showed a higher von Mises stress value than patients in the normal group (P < 0.001), but statistically speaking the values between patients in the OP and normal groups were insignificant (P > 0.05). Conclusions The relatively shorter inner and outer diameters of the isthmus in DDH resulted in intensive von Mises stress under the torque of the hip location, and induced a high fracture incidence. However, in patients in the OP group, the geometric morphology exhibited no anatomical variation, and the fracture was not due to the intensity of von Mises stress.

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Is there a difference in pelvic and femoral morphology in early periprosthetic femoral fracture in cementless short stem total hip arthroplasty via an anterolateral approach?

Luger,

Feldler,

Schopper

et al. 2024

J Orthop Traumatol

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Background The pelvic and femoral morphology are associated with the occurrence of early periprosthetic femoral fractures (PFFs) in cementless total hip arthroplasty (THA). Differences exist depending on the performed approach and implanted stem design. Therefore, this study was conducted to analyze the pelvic and femoral morphology in cementless short stem THA via a minimally-invasive (MIS) anterolateral approach. Methods A retrospective, single-center, multi-surgeon, comparative propensity-score matched study of a cohort of 1826 short stem THAs was conducted. A total of 39 PFFs within the first 90 days after surgery was matched on a 2:1 ratio to non-fracture patients. The morphology of the proximal femur was analyzed with canal flare index (CFI), canal-calcar ratio (CCR), canal-bone ratio (CBR), morphological cortical index (MCI), and femoral cortical index (CI). The pelvic morphology was analyzed with ilium–ischial ratio (IR), distance anterior superior iliac spine to the tip of the greater trochanter (AGT). Both groups were analyzed regarding several parameters for femoral and pelvic morphology in non-parametric testing and univariate regression analysis. Results A significantly higher AGT was detected in the fracture group (104.5 mm ± 18 versus 97.4 mm ± 9.8; p = 0.016). All other femoral and pelvic parameters did not differ between both groups, also when compared depending on the Vancouver type of the PFF. Conclusions The morphology of the proximal femur and the pelvis do not differ in several radiological parameters in patients sustaining a PFF in cementless short stem THA via an anterolateral approach compared with matched non-fracture group. The findings are controversial to other studies with different stem types and approaches. Future studies should focus on analyzing the influence of the pelvic geometry and the shape of the proximal femur in the occurrence of PFFs in different approaches with the same stem type and vice versa. Level of Evidence Level III case-controlled study

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Risk factors for femoral fracture in lateral decubitus direct anterior approach total hip arthroplasty using conventional stems: a retrospective analysis

Cited by 4 publications

References 28 publications

Current perspectives of south african orthopaedic surgeons to the direct anterior approach in total hip arthroplasty

Current perspectives of south african orthopaedic surgeons to the direct anterior approach in total hip arthroplasty

Biomechanical Characteristics of the Femoral Isthmus during Total Hip Arthroplasty in Patients with Adult Osteoporosis and Developmental Dysplasia of the Hip: A Finite Element Analysis

Is there a difference in pelvic and femoral morphology in early periprosthetic femoral fracture in cementless short stem total hip arthroplasty via an anterolateral approach?

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